Researchers Develop and Test Six-Question Tool to Screen Adolescents for Substance Abuse in Health Care Settings

Increasing adolescent substance abuse screening in health care settings

From May 2002 through April 2006, researchers at Boston Childrens Hospital tested and developed procedures for implementing a screening tool for adolescent substance abuse in various health settings.

The research team, led by John R. Knight, MD, had refined and validated the six-question tool, called CRAFFT, under a previous grant from the Robert Wood Johnson Foundation (RWJF). See the Program Results Report on ID# 036126.

Key Results

  • The project team:

    • Developed a computer program that delivers the CRAFFT screening and personalized feedback to the patient.
    • Designed a brief office-based intervention for physicians to deliver to adolescent substance users.
    • Screened 2,133 adolescents at seven participating clinics using CRAFFT. There were 222 screenings done via computer; a research assistant screened the remaining 1,911.

Key Findings

  • In an article appearing in the Journal of Adolescent Health, the investigators reported the following finding based on focus groups with primary care providers:

    • The most common barriers to substance abuse screening in primary care practices were "the six T's": Not enough time; lack of training to deal with positive screens; the need to triage competing medical problems; lack of treatment resources; tenacious parents won't leave the room; unfamiliarity with appropriate screening tools.
  • In an article to appear soon in the Archives of Pediatrics & Adolescent Medicine, the investigators report:

    • Of the participants screened with CRAFFT, 14.8 percent were positive.
    • The highest positive rates were at school-based health centers and the rural family practice.
    • Researchers estimated that across the entire sample:
      • 56.5 percent of participants were abstinent.
      • 11.3 percent had problematic use.
      • 7.1 percent met standard criteria for a diagnosis of substance abuse.
      • 3.2 percent met criteria for a diagnosis of substance dependence.
    • Sick visits had a higher positive rate (23.2%) than well care visits (11.1%).
  • Findings from a survey about screening preferences that participants completed independently indicated that more participants (74.9%) reported being "very comfortable" using paper as their screening administration method than screening via a computer or interviews with doctors or nurses.